Factors influencing treatment response and outcome of first-episode schizophrenia: implications for understanding the pathophysiology of schizophrenia.
Factors influencing treatment response and outcome of first-episode schizophrenia: implications for understanding the pathophysiology of schizophrenia.
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发表时间：
1996
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通讯作者：
J. Lieberman;A. Koreen;M. Chakos;B. Sheitman;M. Woerner;J. Alvir;R. Bilder
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作者：
J. Lieberman;A. Koreen;M. Chakos;B. Sheitman;M. Woerner;J. Alvir;R. Bilder
对于大多数患者来说，精神分裂症是一种慢性复发性疾病，通过行为恶化过程导致显著的残留发病率。影响精神分裂症发病后病程的因素以及治疗改变患者疾病影响的能力尚不清楚。本文探讨了与治疗反应和结果相关的特定临床和生物学变量。这些变量，这是特质和状态依赖，包括发病前的调整，发病的年龄和模式，性别，精神病的持续时间，精神分裂症亚型，主要的阴性症状，和锥体外系体征，包括迟发性运动障碍和血浆HVA和脑病理形态学。此外，抗精神病药物治疗的慢性效应可能对病程产生有利和不利的影响，并可能改变介导疾病表达和治疗反应的神经生物学底物。最后，讨论了疾病的活动期是否涉及导致疾病进展的病理过程。根据这一讨论，我们可以推测，尽管疾病的某些方面在其严重程度和过程方面可能在某种程度上是预先确定的，但许多因素可以对疾病的过程及其最终结果产生有利和不利的影响。该领域的一个问题是开发治疗策略，以不向患者引入医源性后果的方式最小化疾病的发病率。
For the majority of patients, schizophrenia is a chronic recurrent disease that leads to significant residual morbidity which occurs through a process of behavioral deterioration. The factors that influence the course of schizophrenia after its onset and the ability of treatment to modify the effects of the patient's illness are not well understood. This article examines specific clinical and biological variables that are associated with treatment response and outcome. These variables, which are both trait and state dependent, include premorbid adjustment, age and mode of onset of illness, gender, duration of psychosis, schizophrenia subtype, primary negative symptoms, and extrapyramidal signs including tardive dyskinesia and plasma HVA and brain pathomorphology. In addition, the chronic effects of antipsychotic drug treatment may influence illness course both favorably and adversely as well as potentially altering the neurobiological substrates that mediate expression of the illness and treatment response. Finally, the question of whether the active phase of the illness involves a pathologic process that leads to illness progression is discussed. In light of this discussion, we can speculate that although certain aspects of the illness in terms of its severity and course may be, to an extent, predetermined, a number of factors can exert favorable and unfavorable effects on the course of the illness and its ultimate outcome. One question for the field is to develop therapeutic strategies that minimize the morbidity of the illness in a way that does not introduce iatrogenic consequences to the patient.